How to Write a Good Discharge Summary
April 25, 2026
How to write a good discharge summary Writing a high-quality discharge summary is a vital skill for any resident (junior) doctor. It isn’t just paperwork; it is the primary communication b...
Navigating the hierarchy of a UK hospital can be confusing. With the official move from “junior” to resident doctors and the expansion of specialist grades, understanding who is treating you is more important than ever.
GPs are senior doctors who have completed specialized training in general medicine. They are the “front door” of the NHS.
GP Partners: The “owners” or bosses of a GP surgery.
Salaried GPs: Senior doctors employed by the practice.
Locum GPs: Temporary doctors covering shifts.
The Role: For every 20 patients a GP sees, they typically manage 19 in the community and refer only one to a hospital specialist.
Hospital doctors are categorized into three main groups: Senior Doctors (Consultants), SAS Doctors, and Resident Doctors.
A. Hospital Consultant (The “Boss”)
The most senior grade. Consultants have completed full specialist training and are on the GMC’s Specialist Register.
Responsibility: They have ultimate clinical responsibility for every patient admitted under their name.
Titles: Most use “Dr,” but surgeons—due to a 200-year-old tradition—often use Mr, Miss, Ms, or Mrs.
B. SAS Doctors (The Experienced Permanent Staff)
SAS stands for Specialist, Associate Specialist, and Specialty doctors. These are highly experienced senior doctors who have chosen a permanent career grade instead of the traditional consultant pathway.
Specialist Grade: A senior tier introduced for highly autonomous SAS doctors.
Specialty Doctor: Senior doctors with at least four years of postgraduate experience.
Why it matters: SAS doctors provide the “hands-on” continuity in hospitals and often have more patient contact than consultants.
C. Resident Doctors (Formerly “Junior Doctors”)
As of August 2024, the term “junior doctor” is no longer used. Resident Doctors are fully qualified physicians undergoing further training to become GPs or Consultants.
Registrar (ST3–ST8): Senior residents with 5–10 years of experience. They often run the hospital at night and perform operations.
Senior House Officer (SHO/CT1–CT2): Intermediate residents gaining core specialty experience.
Foundation Doctor (FY1–FY2): Doctors in their first two years after medical school. FY1s have “provisional” registration; FY2s are fully registered with the GMC.
In university (teaching) hospitals, you may encounter doctors with academic titles:
Professor: A consultant who also leads a university department or major research.
Reader / Associate Professor: A senior clinical academic.
Clinical Fellow: A resident doctor (usually a registrar) who splits their time between patient care and research.
| Stage | Title | Years of Training |
| Medical School | Medical Student | 4–6 Years |
| Foundation Year 1 | Resident Doctor (FY1) | 1 Year |
| Foundation Year 2 | Resident Doctor (FY2) | 1 Year |
| Core/Specialty Training | Resident (SHO or Registrar) | 3–8 Years |
| Completion (CCT) | Consultant or GP | Final Goal |
1. Is a “Resident Doctor” a student?
No. Resident doctors are fully qualified, prescribing physicians. Some have over a decade of experience and are experts in their field; they are simply in the “residency” phase of reaching consultant status.
2. Why is my surgeon called “Mr” instead of “Doctor”?
In the 18th century, surgeons were “barber-surgeons” and did not have medical degrees, while physicians did. When surgeons became highly trained professionals, they kept the title “Mr” as a badge of honor to distinguish themselves from physicians.
3. What is a “Trust Grade” doctor?
A Trust Grade doctor is a doctor employed directly by a specific hospital (Trust) rather than being on a national training rotation. They are often equivalent to the SHO or Registrar level.
4. Who is the most senior doctor on the ward?
The Consultant is the most senior. If the consultant is not present, the Registrar is usually the most senior “resident” doctor on site.
How to write a good discharge summary Writing a high-quality discharge summary is a vital skill for any resident (junior) doctor. It isn’t just paperwork; it is the primary communication b...
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